The present invention relates to an automated microbiological analyzer for determining the identity of an infecting microorganism in a liquid sample. More particularly, the present invention provides a centrifugal rotor containing the appropriate reagents for performing various microorganism identity determinations and adapted for use in a totally automated microbiological analyzer.
Various types of clinical tests related to patient diagnosis and therapy can be performed by analysis of a biological sample. Biological samples containing the patient""s microorganisms are taken from a patient""s infections, bodily fluids or abscesses, plated, and placed in a suspension. The suspension is combined with appropriate reagents in analytical wells in test panels or arrays, incubated, and analyzed to aid in treatment of the patient. Automated biochemical analyzers have been developed to meet the needs of health care facilities and other institutions to accelerate analysis of patient samples and to improve the accuracy and reliability of assay results when compared to analysis using manual operations. However, with ever changing bacterial genera and newly discovered antibiotics, the demand for biochemical testing has increased in complexity and in volume. Because of these greater demands, taken in conjunction with the expense and scarcity of floor space within health care institutions and the pressure to provide clinical results at lower costs, it has become important to simultaneously perform various types of biochemical tests within a highly automated and compact analyzer that operates with minimal clinician attention using cost-effective techniques.
An important family of automated microbiological analyzers function as a diagnostic tool for determining the identity of an infecting microorganism and of an antibiotic effective in controlling growth of the infecting microorganism. In performing these test, identification and in vitro antimicrobic susceptibility patterns of microorganisms isolated from biological samples are ascertained. Such analyzers have historically placed selected biochemicals into a plurality of small sample test microwells in centrifugal rotors that contain different substrates, or in multi-well panels having antimicrobics in serial dilutions, depending on the type of test being performed. Identification (ID) of microorganisms and of Minimum Inhibitory Concentrations (MIC or AST) of an antibiotic effective against the microorganism are determined by monitoring changes in the test microwells. By examining the signal patterns generated in the array of microwells, both ID and MIC measurements and subsequent analysis may be performed by computer controlled microbiological analyzers to provide advantages in reproducibility, reduction in processing time, avoidance of transcription errors and standardization for all tests run in the laboratory.
In ID testing of a microorganism, a standardized dilution of the patient""s microorganism sample, known as an inoculum, is first prepared in order to provide a bacterial or cellular suspension having a predetermined known concentration. This inoculum is placed in an analytical test array or panel having a number of microwells or alternately into a cuvette rotor assembly having a central inoculum receiving chamber from which sample is distributed by centrifugal force to a number of test microwells or chambers located at the periphery of the rotor. The test wells contain predetermined identification media typically consisting of enzyme substrates, which, depending on the species of microorganism present, will exhibit color changes, increases in turbidity or changes in fluorescence after incubation. For instance, a bacterial genera may be identified on the basis of pH changes, its ability to utilize different carbon compounds, or growth in the presence of antimicrobial agents in a test well. Some tests require addition of reagents to detect products of bacterial metabolism while others are self-indicating. In conventional chromogenic panels, the inoculum is incubated some 18-24 hours before analysis is completed. Alternately, microorganism ID may be accomplished using rapid fluorogenic test arrays employing growth-independent means in which preformed enzyme substrates are placed in the test wells and fluorogenic tests based on the detection of hydrolysis of fluorogenic substrates, pH changes following substrate utilization, production of specific metabolic substrates and the rate of production of specific metabolic byproducts are made after about 2 hours of incubation. In both cases, by examining the reaction, or lack thereof, of the inoculum and reagents after incubation and over a period of time and comparing that reaction with that of known species, the types of microorganisms can be identified. Importantly, a large number of different substrates or other reagents must be available in ID testing of an unknown microorganism because the microorganism will be more or less different sensitive to different substrates and reagents. In an automated analyzer, this is achieved by providing a variety of ID test panels, each pre-loaded with substrates and reagents that are selected to produce a known pattern of measurable reaction signals for various microorganisms.
Important challenges that must be taken into consideration when designing automated biochemical analyzers that can quickly and cost-effectively perform ID biochemical tests include the volume of reagents required per test and the cost of a ID test panel, array or other device like a centrifugal ID test rotor. Because they are small and may be produced using mass-production, plastic injection molding techniques, it is advantageous to use small sized test devices having a large number of micro-liter sized microwells for performing ID tests in order to facilitate automatic handling and minimize the expense of the ID test device. Centrifugal ID test rotors like that of the present invention typically consist of a plurality of microwells that function as reaction vessels or microwells arrayed near the periphery of a generally flat disk in which the above mentioned ID biochemical tests are conducted. An aliquot of a patient""s sample is placed in each microwell along with appropriate biochemical reagents, after which the rotors is generally incubated at a controlled temperature for a period of time so that an observable reaction between the sample and reagents occurs. At predetermined time intervals, each microwell of the ID rotor is examined for an indication of changes in color change, turbidity, or other observable reaction result. The pattern of changes may then be compared with reaction signal patterns of known microorganisms enabling the identification of the any microorganism within the sample, as discussed above.
Cost-effectively providing ID test devices with the required substrates and/or reagents to perform physician requested ID tests presents technical challenges that are made increasingly difficult as the numbers of the available ID substrates and/or reagents are increased. Efforts have been made to address these challenges along with other problems and some of these employ a centrifugally activated microwell filling process using an ID rotor having a large number of micro-sized channels radially connecting the test microwells to a supply reservoir near the center of the rotor. Reagents and/or test samples are placed within the supply reservoir and moved by centrifugal force through the microchannels to the test microwells.
Typical of these rotors are those described in U.S. Pat. Nos. 4,123,173, 3,555,284 and 4,387,164. While satisfactory for their intended purposes these rotors do not fulfill all the needs that exist for a small disposable rotor that is capable of accurately providing many tests on a single sample. These rotors are comprised of two disk-like rigid plastic pieces secured together to form a closed rotor. The lower disk has a central hub for mounting on a rotor drive shaft and comprises a flat disk having a central receptacle and a plurality of peripheral cells formed therein. Each cell is separated from an adjacent cell by a raised radial ridge which forms sectors for each cell. A radial groove of capillary thickness dimensions extends from the central receptacle formed in the lower disk to the center, radially inner portion of each cell.
One problem inherent in the above designs is that different chemistries, different dilutions or different fluids are necessary; therefore, more than one central well is required. This is typically accomplished by placing a baffle in the central receptacle. Without the baffle all cells are subjected to the same pressure. With the baffle in the central cavity, due to acceleration, the cells nearest the leading edge of the baffle tend to be filled first. Also, it is sometimes difficult to fill all of the cells completely since the groove tends to become filled with liquid trying to exit the central receptacle under centrifugal force. This can result in filling differences and difficulty of completely filling a particular cell with fluid from the central receptacle.
U.S. Pat. No. 6,096,272 discloses a diagnostic microbiological testing system and method for both microorganism identification (ID) and antimicrobial susceptibility determinations (AST). The system includes multiple-well test panels capable of performing ID and AST testing on the same test panel. Each test panel is inoculated with reagents, broth-suspended organisms, and placed into the instrument system. The instrument system includes a rotating carousel for incubation and indexing, multiple light sources each emitting different wavelength light, precision calorimetric and fluorometric detection, barcode test panel tracking, and a control processor for making determinations based on measured test data.
U.S. Pat. No. 5,863,754 discloses a process for bacteria identification (ID) and for determining the sensitivity of bacteria to antibiotics (AST), and an apparatus and measuring supports for carrying out this process. A given volume of bacterial colony is introduced into a primary receiver and is dispersed within a liquid to form a precalibrated inoculum. This inoculum is moved between the primary receiver and one or more measuring supports so that the transferred quantities of bacteria correspond to the quantities required for the analyses to be carried out. Measurements are taken on the content of the compartments during or at the end of one or more incubations, and processed in order to characterize the growth of the bacteria present in the inoculum, to identify them and/or to determine their sensitivity to various antibiotics.
U.S. Pat. No. 5,631,166 discloses a disk for holding, centrifuging and microscopically viewing fluid samples. The disk includes a plurality of reaction wells radiating outwardly and includes a barrier to restrain particles during centrifugation. This disk is used in an apparatus having sample loading, mixing, centrifuging, incubating, viewing and sterilizing stations.
U.S. Pat. No. 5,627,041 discloses a rotary cartridge to present a biological sample for analysis by an imaging instrument. The cartridge utilizes a series of channels, capillaries, reservoirs and stop junctions to move a sample, reagent and diluent through the cartridge as a function of the sum of capillary, gravitational and low centrifugal forces.
U.S. Pat. No. 5,591,643 provides centrifugal rotors for delivering a biological sample to an unvented chamber in the rotor through an unmodified inlet channel. The unvented chamber is typically a cuvette comprising reagents necessary for analysis of a biological sample. The unmodified inlet channels are sized such that, as the rotor spins, gas escapes from the chamber through the inlet channel as the liquid enters the chamber through the inlet channel. The primary feature which allows the air to escape from the unvented chamber is that the cross sectional area of the inlet channel is greater than the cross sectional area of the liquid flowing through it.
U.S. Pat. No. 5,266,268 discloses a multi-well rotor which reduces tendencies of reagent or a sample material to spontaneously move or xe2x80x9cwickxe2x80x9d from one chamber compartment to the other, resulting in premature co-mingling of reactants, and of sample or reagent material to flow out of one or more of the outer loading ports during acceleration of the rotor for transfer of the sample or reagent material from inner chambers to corresponding outer chambers.
U.S. Pat. No. 5,186,896 discloses a cuvette rotor having at least one radially extending cuvette with a first chamber, a second chamber and a third chamber. A first barrier defines a boundary between the first and second chambers, and a second barrier defines a boundary between the second and third chambers. At least one vessel having top and bottom walls is arranged on the rotor adjacent the cuvette, the vessel being separated from the cuvette by a side wall, and the top wall of the vessel including a fourth port.
U.S. Pat. No. 4,814,144 provides a rotor unit for a centrifugal analyzer with a rotor base connected with a drive and a rotor head including chambers for the reception of a sample liquid, measuring chambers to detect components of the sample, as well as liquid channels for connecting the sample chambers with the measuring chambers. The rotor head comprises a plurality of different insert elements which are exchangeable within the rotor base at different selectable positions. Each insert element may contain pre-packed reagents in solid form which are dissolved and mixed with diluted sample.
U.S. Pat. No. 4,756,883 discloses a centrifugal analysis device in which a plastic rotor has peripheral cells each containing a reagent. The rotor is configured such that sample fluid within a central receptacle is equally dispensed to each of the peripheral cells. An outlet orifice is positioned at a radial distance greater than the inlet orifice to each cell such that each cell is completely filled with fluid, and simultaneously filled such that all reactions take place at the same beginning point.
U.S. Pat. No. 4,314,970 discloses a multicuvette rotor having a circumferential array of spaced radially extending recesses with a divider member in each recess to define a first chamber and a second chamber radially outward from the first chamber. A ring member that has a mating reference surface is seated on a reference surface of the array. A circumferential array of first optical windows is bonded to the ring member and a circumferential array of second optical windows is bonded to the base of the array in alignment with the first optical windows. A cover member has sealing surfaces that mate with edges of recesses within the array and an inner peripheral lip of the ring member to provide a continuous seal of the recesses to retain reagent and sample material to be analyzed within the recesses.
From this discussion of the art state in automated microbiological analyzers, it may be seen that microbiological analyzers employ complex multiple-well test rotors capable of performing ID testing on a sample are not truly fully automated. In particular, in the analyzer described in the family of patents related to U.S. Pat. No. 5,762,873 discussed above, prior to the start of a testing procedure, a technician manually loads a cassette with a plurality of test cards wherein the test cards come in two varieties: (1) identification cards, in which particular different growth media are placed in each of the wells of the card when the cards are manufactured, and (2) susceptibility cards, in which different concentrations of different antibiotics are placed in each of the wells of the card. In the analyzer described in U.S. Pat. No. 6,096,272 discussed above, a technician must inoculate a combination ID/AST test panel with an unknown microorganism and then manually place that panel into the analyzer where it is then incubated and analyzed periodically. From this it may be seen that prior to the use of such state-of-the art microbiological analyzers, an operator is required to select the particular ID and/or AST test cards or devices that are required to perform the analyses called for by a physician and then either: (1) to inoculate and load the selected ID and/or AST test cards onto the analyzer, or (2) to load the selected ID and/or AST test cards onto the analyzer where the cards are automatically inoculated with test sample.
In addition, ID test rotors are frequently provided with a number of complexly configured microchannels, cover members that must seal with base members, various outlet and inlet orifices, channels, capillaries, reservoirs and stop junctions, etc., to uniformly transfer a given amount of sample from a loading port to a number of ID test microwells. These features are costly to provide.
Hence there remains a unmet need for improved ID test rotors pre-loaded with the substrates, growth media and/or reagents required to perform a wide variety of ID determinations adapted for use in a fully automated microbiological analyzer having the flexibility to perform a wide variety of ID determinations without requiring a technician to pre-select and individually load rotors onto the analyzer. There is an even further need for such an ID rotor to have low-cost manufacturing features and to be simply operable via centrifugal means to uniformly distribute a sample to a large number of small ID test microwells.
The present invention meets the foregoing needs by providing a simple and low-cost ID test rotor adapted for performing different ID tests and for use in a fully automated microbiological test analyzer. A particular embodiment of the present invention is directed at an ID test rotor preloaded with substrates and reagents that are selected to produce a known pattern of measurable reaction signals that correspond to the identity of various known microorganisms. Incoming patient samples to be tested are bar-coated with identifying indicia from which the ID tests that are desired to be accomplished may be established by the analyzer. The analyzer then automatically selects the numbers of different ID test rotors required to complete the requested ID protocols from rotors housed in a number of different tube-like ID canisters maintained on a rotatable carousel. The ID test rotors have unique features that enable a rotor to be removed from the canister, to be easily loaded with sample, to be subjected to a centrifuging action, to be transported to a sample incubation and testing station, and to be positioned within such an incubation and testing station where the ID rotor may be examined for reaction results. Test results obtained from a plurality of microwells located in a pair of circular arrays are automatically compared with reaction signal patterns of known microorganisms thereby enabling the identification of any microorganism within the sample.